The Experts below are selected from a list of 5388 Experts worldwide ranked by ideXlab platform
R. H. Belmaker - One of the best experts on this subject based on the ideXlab platform.
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Ritual Female Genital Surgery Among Ethiopian Jews
Archives of sexual behavior, 1997Co-Authors: Nimrod Grisaru, Simcha Lezer, R. H. BelmakerAbstract:Ritual female Genital Surgery is usually associated with Muslim countries although it is normative also among Ethiopian Coptic Christians. Ethiopian Jewish women immigrants to Israel report that ritual female Genital Surgery was normative in their culture in Ethiopia, but expressed no desire to continue the custom in Israel. This contrasts with Israeli Bedouin Muslims, who were reported to regard ritual female Genital Surgery as an important part of their identity. Physical examination of 113 Ethiopian Jewish immigrant women in Israel found a variety of lesions in about a third of women, with 27% showing total or partial clitoral amputation. The heterogeneity of the physical findings contrasts with uniform verbal reports in interviews of having undergone a ritual of female Genital Surgery.
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Ritual female Genital Surgery among bedouin in Israel
Archives of Sexual Behavior, 1995Co-Authors: Abed Asali, Naif Khamaysi, Yunis Aburabia, Simha Letzer, Buteina Halihal, Moshe Sadovsky, Benjamin Maoz, R. H. BelmakerAbstract:Ritual female Genital operations are common in many parts of the world, with varying degrees of mutilation from clitoridectomy and removal of the labia to removal of the clitoral prepuce. Interviews of 21 Bedouin women in southern Israel revealed the practice to be normative in several tribes. However, physical examination of 37 young women from those tribes at a gynecological clinic revealed only small scars on the labia in each woman. Bedouin in southern Israel may offer a model of evolution of female circumcision into a nonmutilative ritual incision.
Sarah M. Creighton - One of the best experts on this subject based on the ideXlab platform.
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Parental choice on normalising cosmetic Genital Surgery
BMJ (Clinical research ed.), 2015Co-Authors: Lih-mei Liao, Dan Wood, Sarah M. CreightonAbstract:Between a rock and a hard place About 1 in 2000 children are born with Genitalia considered atypical enough to prompt medical investigation. Underlying causes include complex genetic and hormonal conditions as well as unexplained anatomical anomalies such as hypospadias. Paediatricians have previously stated that the determining factor in deciding to raise a child as a boy is the “size of the phallus.”1 2 Newborn penile size charts were used in the 1960s, and any child with a penis of stretched length less than 2.5 cm was likely to be assigned female regardless of the underlying diagnosis; feminising Genital Surgery usually followed.1 Gender assignment has become less simplistic but normalising Surgery remains common. As a result, little is known about the physical, psychological, social, and sexual effects of untreated atypical Genitalia associated with different diagnoses. It has been impossible to determine to what extent difficulties reported by adults are caused by the anatomical difference, other aspects of the diagnosis, the imperfect results of Surgery, poor psychological care, or a combination of these factors. …
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childhood Surgery for ambiguous Genitalia glimpses of practice changes or more of the same
Psychology and Sexuality, 2014Co-Authors: Sarah M. Creighton, Lina Michala, Imran Mushtaq, Michal YaronAbstract:The Chicago consensus statement of 2005 was created at the point of cumulative criticisms and debates around the clinical practice of childhood Genital Surgery. It was drawn up at a time when it had become clearer that medically non-essential paediatric Genital operations were associated with poor adult cosmetic outcomes and sexual functioning. However, data were not available for non-intervention. Therefore, parents and clinicians had no reliable information on how a child growing up with atypical Genitalia might fare. The most positive recommendation in the consensus statement was the strong recommendation for decisions to be reached by a multidisciplinary team in collaboration with affected families. Importantly, the value of user groups was likewise formally acknowledged. For many services, there has been a sea change in the way surgeons work. Whilst some surgeons may continue with the standard practice of childhood Genital Surgery, it is becoming clearer that with adequate support, more individuals a...
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Timing and nature of reconstructive Surgery for disorders of sex development - introduction.
Journal of pediatric urology, 2012Co-Authors: Sarah M. Creighton, Steven D. Chernausek, Rodrigo L.p. Romao, P.g. Ransley, Joao L. Pippi SalleAbstract:Abstract The ideal timing and nature of surgical reconstruction in individuals with Disorders of Sex Development (DSD) is highly controversial. Despite the increasing number of publications on this topic, evidence-based recommendations still cannot be made. However it is generally accepted that optimal care for DSD requires an experienced multidisciplinary team. This means that surgical decisions are now made within the context of a multidisciplinary team and all members of the team – and not just specialist surgeons – may be called upon to discuss choices for Surgery with patients and parents. To do this well, every clinician in the team should have an understanding of the range of techniques available for Genital Surgery, the risks and benefits of procedures and the controversies surrounding timing of Surgery. The aim of this paper is to give an overview of the variety of surgical procedures in current use and in what situation a particular technique would be indicated. The short-term risks and benefits are described and where available long-term outcome data is discussed. To date, discussions surrounding Genital Surgery have been led primarily by surgeons. Some non-surgical clinicians have expressed unease about decision making in Genital Surgery but have felt ill equipped to comment on an area with which they are unfamiliar. This review gives a detailed explanation of current surgical practice offered in a specialized center for DSD and such information should facilitate a more balanced discussion.
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adult female outcomes of feminising Surgery for ambiguous Genitalia
Pediatric endocrinology reviews, 2004Co-Authors: Sarah M. CreightonAbstract:For the last half a century, feminising Genital Surgery has been routine practice for children with ambiguous Genitalia assigned to a female sex of rearing. Due to various factors including the stigma and secrecy associated with intersex and the practical difficulties of paediatricians following-up adult patients, there has been little available outcome data on this policy. Recently however adult peer support groups have expressed dissatisfaction with the results of Surgery. In addition there is increasing data to confirm a high rate of repeat vaginoplasty as well as a detrimental effect on adult sexual function. The lack of outcome data supporting this policy of Genital Surgery for all means it is time to radically evaluate our clinical practice. The option of psychological and peer support as an alternative to routine Genital Surgery must become a realistic proposition.
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The Adult Consequences of Feminising Genital Surgery in Infancy. A Growing Skepticism
Hormones (Athens Greece), 2004Co-Authors: Sarah M. CreightonAbstract:The Role of Surgery Current standard practice in Europe and North America advocates feminising Genital Surgery for all children with ambiguous Genitalia assigned to a female sex of rearing. A standard infant feminising genitoplasty involves removal of some of the clitoris to reduce its size, construction of a vagina or opening the vaginal introitus and sometimes refashioning of the labia. In some European centres removal of the whole clitoris (clitorectomy) is still the procedure of choice for the enlarged clitoris. Proponents of feminising genitoplasty in infancy cite both psychological reasons such as stable gender identity development and a better psychosexual and psychosocial outcome as well as physical reasons such as menstruation and sexual intercourse in later life. It is important for clinicians to know whether all or any of these outcomes are achieved and this information can only be obtained by well designed long-term follow-up studies.
David E. Sandberg - One of the best experts on this subject based on the ideXlab platform.
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Does Patient-centered Care Change Genital Surgery Decisions? The Strategic Use of Clinical Uncertainty in Disorders of Sex Development Clinics:
Journal of health and social behavior, 2018Co-Authors: Stefan Timmermans, Ashelee Yang, Melissa Gardner, Catherine E. Keegan, Beverly M. Yashar, Patricia Y. Fechner, Margarett Shnorhavorian, Eric Vilain, Laura A. Siminoff, David E. SandbergAbstract:Genital Surgery in children with ambiguous or atypical Genitalia has been marred by controversies about the appropriateness and timing of Surgery, generating clinical uncertainty about decision mak...
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psychological aspects of the treatment of patients with disorders of sex development
Seminars in Reproductive Medicine, 2012Co-Authors: David E. Sandberg, Melissa Gardner, Peggy T CohenkettenisAbstract:Research on the psychological development of persons with Disorders of Sex Development (DSD) has focused on understanding the influence of atypical sex hormone exposure during steroid-sensitive periods of prenatal brain development on the process of psychosexual differentiation (i.e., gender identity, gender role, and sexual orientation). In contrast, analysis of clinical management strategies has focused on gender assignment and the desirability and timing of Genital Surgery. This review focuses on the psychological issues that confront clinicians managing the care of persons born with DSD and their families. Particular attention is paid to processes and factors that potentially mediate or moderate psychosocial and psychosexual outcomes within and across developmental stages.
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Psychosocial Adaptation of Middle Childhood Boys With Hypospadias After Genital Surgery
Journal of pediatric psychology, 2001Co-Authors: David E. Sandberg, Heino F. L. Meyer-bahlburg, Terry W. Hensle, Selwyn B. Levitt, Stanley J. Kogan, Edward F. RedaAbstract:Objective: To compare the psychosocial adaptation of boys with hypospadias after Genital Surgery to a community sample. Methods: Boys (6 to 10 years) with a history of hypospadias repair (n = 175) were compared with a community sample (n = 333) in a postal questionnaire survey using the Child Behavior Checklist. Results: Few significant differences between cases and controls emerged. Boys with hypospadias were (slightly) lower in social involvement but did not perform more poorly in school. Boys with hypospadias displayed fewer externalizing behavior problems than controls, but a significant difference in nocturnal enuresis was not detected. Level of behavior problems did not differentiate hypospadias severity subgroups, but greater surgical and hospitalization experiences were associated with increased internalizing problems. Poorer cosmetic appearance of the Genitals was associated with worse school performance. Conclusions: Surgically corrected hypospadias should not be considered a risk factor for poor psychosocial adaptation in childhood, but emotional problems increase with the number of hospital-related experiences.
Boris B Gorzalka - One of the best experts on this subject based on the ideXlab platform.
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continuing medical education sexual functioning in transsexuals following hormone therapy and Genital Surgery a review cme
The Journal of Sexual Medicine, 2009Co-Authors: Carolin Klein, Boris B GorzalkaAbstract:ABSTRACT Introduction Sexual function following Genital sexual reassignment Surgery (SRS) is an important outcome for many transsexuals, affecting the choice of surgical technique, satisfaction with Surgery, and quality of life. However, compared to other outcome measures, little clinical and research attention has been given to sexual functioning following SRS. Aim To discuss the potential impact of cross‐sex hormone therapy and SRS on sexual function and to summarize the published empirical research on postsurgical sexual functioning in male‐to‐female (MtF) and female‐to‐male (FtM) transsexuals. Methods Cross‐sex hormone therapy and SRS techniques are outlined, the potential roles of cross‐sex hormone therapy and SRS on sexual function are discussed, and peer‐reviewed literature published in English on postoperative sexual functioning in MtF and FtM transsexuals is reviewed. Main Outcome Measures Sexual desire, sexual arousal, and ability to achieve orgasm following SRS. Results Contrary to early views, transsexualism does not appear to be associated with a hyposexual condition. In MtF transsexuals, rates of hypoactive sexual desire disorder (HSDD) are similar to those found in the general female population. In FtM transsexuals, sexual desire appears unequivocally to increase following SRS. Studies with MtF transsexuals have revealed not only vasocongestion, but also the secretion of fluid during sexual arousal. Research on sexual arousal in FtM transsexuals is sorely lacking, but at least one study indicates increased arousal following SRS. The most substantial literature on sexual functioning in postoperative transsexuals pertains to orgasm, with most reports indicating moderate to high rates of orgasmic functioning in both MtF and FtM transsexuals. Conclusions Based on the available literature, transsexuals appear to have adequate sexual functioning and/or high rates of sexual satisfaction following SRS. Further research is required to understand fully the effects of varying types and dosages of cross‐sex hormone therapies and particular SRS techniques on sexual functioning. Klein C, and Gorzalka BB. Sexual functioning in transsexuals following hormone therapy and Genital Surgery: A review.
Ute Thyen - One of the best experts on this subject based on the ideXlab platform.
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Early Genital Surgery in Disorders/Differences of Sex Development: Patients’ Perspectives
Archives of Sexual Behavior, 2021Co-Authors: Elena Bennecke, Stephanie Bernstein, Peter Lee, Tim C. Grift, Agneta Nordenskjöld, Marion Rapp, Margaret Simmonds, Jürg C. Streuli, Ute Thyen, Claudia WiesemannAbstract:Controversy continues over a proposed moratorium on elective Genital Surgery in childhood for disorders/differences of sex development (DSD). Empirical evidence on patient preference is needed to inform decision-making. We conducted a multicentre survey by cross-sectional questionnaire in 14 specialized clinics in six European countries. The sample comprised 459 individuals (≥ 16 years) with a DSD diagnosis, including individuals with conGenital adrenal hyperplasia (CAH) ( n = 192), XY DSD with prenatal androgen effect (A) ( n = 150), and without (nA) ( n = 117). Main outcome measures were level of agreement with given statements regarding Genital Surgery, including clitoris reduction, vaginoplasty, and hypospadias repair. A total of 66% of individuals with CAH and 60% of those with XY DSD-A thought that infancy or childhood were the appropriate age for Genital Surgery. Females with XY DSD were divided on this issue and tended to prefer vaginoplasty at a later age (XY DSD-A 39%, XY DSD-nA 32%). A total of 47% of males preferred early hypospadias Surgery. Only 12% (CAH), 11% (XY DSD-A), and 21% (XY DSD-nA) thought they would have been better off without any Surgery in childhood or adolescence. Individuals who had early Genital Surgery were more likely to approve of it. Outcome data failed to support a general moratorium on early elective Genital Surgery. Participant perspectives varied considerably by diagnostic category, gender, history of Surgery, and contact with support groups. Case-by-case decision-making is better suited to grasping the ethical complexity of the issues at stake. Trial registration : German Clinical Trials Register DRKS00006072.
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early Genital Surgery in disorders differences of sex development patients perspectives
Archives of Sexual Behavior, 2021Co-Authors: Elena Bennecke, Stephanie Bernstein, Agneta Nordenskjöld, Marion Rapp, Margaret Simmonds, Jürg C. Streuli, Ute Thyen, Peter A Lee, Tim C Van De Grift, Claudia WiesemannAbstract:Controversy continues over a proposed moratorium on elective Genital Surgery in childhood for disorders/differences of sex development (DSD). Empirical evidence on patient preference is needed to inform decision-making. We conducted a multicentre survey by cross-sectional questionnaire in 14 specialized clinics in six European countries. The sample comprised 459 individuals (≥ 16 years) with a DSD diagnosis, including individuals with conGenital adrenal hyperplasia (CAH) (n = 192), XY DSD with prenatal androgen effect (A) (n = 150), and without (nA) (n = 117). Main outcome measures were level of agreement with given statements regarding Genital Surgery, including clitoris reduction, vaginoplasty, and hypospadias repair. A total of 66% of individuals with CAH and 60% of those with XY DSD-A thought that infancy or childhood were the appropriate age for Genital Surgery. Females with XY DSD were divided on this issue and tended to prefer vaginoplasty at a later age (XY DSD-A 39%, XY DSD-nA 32%). A total of 47% of males preferred early hypospadias Surgery. Only 12% (CAH), 11% (XY DSD-A), and 21% (XY DSD-nA) thought they would have been better off without any Surgery in childhood or adolescence. Individuals who had early Genital Surgery were more likely to approve of it. Outcome data failed to support a general moratorium on early elective Genital Surgery. Participant perspectives varied considerably by diagnostic category, gender, history of Surgery, and contact with support groups. Case-by-case decision-making is better suited to grasping the ethical complexity of the issues at stake. Trial registration: German Clinical Trials Register DRKS00006072.
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satisfaction with Genital Surgery and sexual life of adults with xy disorders of sex development results from the german clinical evaluation study
The Journal of Clinical Endocrinology and Metabolism, 2012Co-Authors: Birgit Kohler, Eva Kleinemeier, Anke Lux, Olaf Hiort, Annette Gruters, Ute ThyenAbstract:Background: Prenatal deficit of androgens or androgen action results in atypical Genitalia in individuals with XY disorders of sex development (XY,DSD). XY,DSD include mainly disorders of gonadal development and testosterone synthesis and action. Previously, most XY,DSD individuals were assigned to the female sex. Constructive Genital Surgery allowing heterosexual intercourse, gonadectomy, and hormone therapy for feminization were often performed. However, outcome studies are scarce. Objective: Our objective was evaluation of satisfaction with Genital Surgery and sexual life in adults with XY,DSD. Design and Methods: We evaluated 57 individuals with XY,DSD from the German multicenter clinical evaluation study with a condition-specific questionnaire. The individuals were divided into subgroups reflecting the absence/presence of partial androgen effect or Genital constructive Surgery. Results: Dissatisfaction with function of the surgical result (47.1%) and clitoral arousal (47.4%) was high in XY,DSD partia...